Dry eye disease (DED) disproportionately affects menopausal women compared to younger women or age-matched men. This condition arises when the eyes do not produce enough tears or when tears evaporate too quickly. DED can significantly impact visual function, disrupting comfort, daily activities, and overall quality of life. The multifaceted nature of DED complicates pinpointing a singular cause; however, inflammation of the cornea and conjunctiva—the thin layer of cells lining the inside of the eyelids and covering the white of the eye—is a key contributor.
The Role of Hormones in Dry Eye Disease
Hormones, including sex hormones, thyroid hormones, insulin, vitamin D, glucocorticoids, prolactin, and growth hormone, play a substantial role in DED. Among sex steroids, low androgen levels are most consistently linked with DED. Studies examining the effects of menopausal hormone therapy (MHT) on DED have produced mixed results—some indicate improvement, while others show no change or even exacerbation of symptoms.
Androgens and Dry Eye Disease
Androgens, such as testosterone, influence DED through several mechanisms:
Meibomian Gland Function: Androgens stimulate the meibomian glands, which produce the lipid component of tears. This lipid layer is critical for stabilizing the tear film and reducing evaporation.
Tear Film Stability: By promoting meibum production, androgens help maintain tear film integrity and hydration, preventing dry eye symptoms.
Anti-inflammatory Effects: Androgens possess anti-inflammatory properties, mitigating inflammation on the ocular surface.
Epithelial Health: They support the health of the ocular surface epithelium, enhancing its barrier function and resistance to environmental irritants.
Ongoing studies are investigating androgen and other hormone-based treatments for DED, but current evidence is insufficient to recommend hormonal therapies for this condition.
Managing Dry Eye During Menopause
There are various strategies to manage DED during menopause:
At-Home Interventions
Artificial Tears: Lubricating eye drops can alleviate dryness and discomfort. Avoid anti-redness or allergy drops, which can worsen symptoms over time.
Eyelid Hygiene: Products like OCuSOFT Lid Scrubs help remove oil, debris, and irritants from the eyelids and lashes.
Lifestyle Adjustments: Stay hydrated, use a humidifier, avoid smoke and dry environments, consume more fatty fish, and take regular breaks during screen use to reduce symptoms.
Addressing Related Conditions: Symptoms such as hot flashes and disrupted sleep can worsen dry eyes. Check thyroid and blood sugar levels, and ensure adequate vitamin D levels to rule out related conditions.
Supplements: Omega-3 fatty acids, particularly EPA and DHA, have demonstrated effectiveness in reducing DED symptoms. Aim for 1–2 grams daily in divided doses for optimal absorption.
Medical Interventions
Prescription Medications: Options include immunomodulators like cyclosporin A (Restasis) and lifitegrast (Xiidra), corticosteroids, NSAIDs, and perfluorohexyloctane (Meibo).
Specialized Treatments: These include punctal plugs, intense pulsed light therapy, scleral lenses, amniotic membranes, and specialized contact lenses.
The Importance of Collaboration
Collaborating with both your menopausal specialist and ophthalmologist ensures the best outcomes for managing DED. If you experience new or worsening symptoms, consult your healthcare provider promptly to identify and address the underlying cause.
